Making sense of celiac disease, gluten allergy and non-celiac gluten sensitivity.

Crown Fountain in Millennium Park, Chicago, Illinois. (Dr. Noorali Bharwani)
Crown Fountain in Millennium Park, Chicago, Illinois. (Dr. Noorali Bharwani)

Celiac disease is a lifelong autoimmune intestinal disorder that runs in families.

The symptoms of celiac disease are triggered by gluten (a protein found in wheat, rye, barley and triticale) in people who are genetically susceptible. Triticale is a hybrid of wheat and rye first bred in laboratories during the late 19th century and can be associated with other immune diseases.

What is non-celiac gluten allergy?

It is a condition with symptoms of celiac disease but the diagnosis cannot be confirmed.

It has taken only 13 years or so to move celiac disease from obscurity into the popular spotlight worldwide. What is more interesting is the spectrum of illnesses associated with ingestion of gluten. Such as allergy to wheat, autoimmune celiac disease, and immune-mediated gluten sensitivity. Sounds complicated? Well, you are not alone.

Research estimates that 18 million Americans have non-celiac gluten sensitivity. That’s six times the amount of Americans who have celiac disease. Researchers are just beginning to explore non-celiac gluten sensitivity.

These individuals seem to be sensitive to gluten often also experience headaches, rashes and fatigue. It is possible that it may in fact be other proteins or sugar in wheat (other than gluten) that may be triggering the reaction. There is no inflammation or damage to the intestinal lining as in celiac disease. More research is needed to understand this problem.

Things to remember about celiac disease are:

A first-degree relative with celiac disease has a 10-fold increased risk of acquiring the condition. It affects one in 133 North Americans.

The risk is increased among people with autoimmune thyroid disease (three to five per cent), type one diabetes mellitus (five to 10 per cent) and Down syndrome (5.5 per cent).

The disease can develop at any age.

Symptoms can be abdominal pain, diarrhea, weight loss and malnutrition.

The most widely available test is the tissue transglutaminase IgA antibody test, which has an estimated 95 per cent accuracy rate. If antibody testing is negative and celiac disease is suspected, the IgA level should be measured.

All adults with an abnormal screening result should undergo a small-bowel biopsy to confirm the diagnosis of celiac disease.

Celiac disease should be considered as a diagnostic possibility in any patient with unexplained iron deficiency anemia, especially if there has been a poor response to oral iron supplementation.

Treatment is lifelong adherence to a gluten-free diet. Examples of gluten-free naturally occurring grains are – oats, buckwheat, millet, rice and quinoa. Gluten-free diet reduces the risk of complications such as osteoporosis and intestinal lymphoma.

Remember, celiac disease is a condition that is fully treatable with dietary modification alone. There are few diseases in medicine that can make this claim.

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